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Spirometry interpretation

geekymedics.com/spirometry-interpretation

July 2, 2018

What is spirometry?
Spirometry is a method of assessing lung function by measuring the volume of air that the
patient is able to expel from the lungs after a maximal inspiration. It is a reliable method of
differentiating between obstructive airways disorders (e.g. COPD, asthma) and restrictive
diseases (e.g. fibrotic lung disease).

Aside from being used to classify lung conditions into obstructive or restrictive patterns, it
can also help to monitor disease severity. This guide aims to provide a basic approach to
spirometry interpretation.

Spirometry provides several important measures including:

Forced expiratory volume in 1s (FEV1) – the volume exhaled in the first second
after deep inspiration and forced expiration, similar to PEFR
Forced vital capacity (FVC) – the total volume of air that the patient can forcibly
exhale in one breath
FEV1/FVC – the ratio of FEV1 to FVC expressed as a percentage

Values of FEV1 and FVC are expressed as a percentage of the predicted normal for a
person of the same sex, age and height.

Reference ranges
FEV1: >80% predicted
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FVC: >80% predicted
FEV1/FVC ratio: >0.7

Patient details
Confirm the patient’s details:

Name
Age
Gender
Height
Ethnicity

Age, gender, height and ethnicity are used to calculate predicted normal values for the
patient.

Assess quality of results


Three consistent volume-time curves are required, of which the best two curves should be
within 5% of each other.

The best of the three consistent readings of FEV1 and FVC should be used in your
interpretation.

The expiratory volume-time graph should also be smooth and free from abnormalities
caused by:

Coughing during expiration


Extra breath during expiration
Slow start to forced expiration
Sub-maximal effort

Abnormalities

Obstructive pattern
FEV1 reduced (<80% of the predicted normal)
FVC reduced, but to a lesser extent than FEV1
FEV1/FVC ratio reduced (<0.7)

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Spirometry: Obstructive lung disease

Reversibility
It can be useful to assess reversibility with a bronchodilator if considering asthma as a
cause of obstructive airway disease.

Patients should be asked to stop bronchodilator therapy prior to spirometry, to ensure


previous treatments do not affect the results (if the patient has severe disease, this would
not be advisable):

Short acting beta-2-agonists should be stopped 6 hours prior to testing


Long acting beta-2-agonists should be stopped 12 hours prior to testing

To assess reversibility, administer 400 micrograms of salbutamol and repeat


spirometry after 15 minutes:

The presence of reversibility is suggestive of asthma


The absence of reversibility suggests fixed obstructive respiratory pathology such as
COPD
Partial reversibility may suggest a coexisting diagnosis of asthma and another
obstructive airway disease (e.g. COPD)

Causes of obstructive lung disease

COPD
Asthma
Emphysema
Bronchiectasis / Cystic fibrosis

Restrictive pattern
FEV1 reduced (<80% of the predicted normal)
FVC reduced (<80% of the predicted normal)
FEV1/FVC ratio normal (>0.7)

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Spirometry: Restrictive lung disease

Causes of restrictive lung disease

Pulmonary causes:

Pulmonary fibrosis
Pneumoconiosis
Pulmonary oedema
Lobectomy/pneumonectomy
Parenchymal lung tumours

Non-pulmonary causes:

Skeletal abnormalities (e.g. kyphoscoliosis)


Neuromuscular diseases (e.g. motor neuron disease, myasthenia gravis, Guillan-
Barre)
Connective tissue diseases
Obesity or pregnancy

References
1. Spirometry in Practice: A Practical Guide to Using Spirometry in Primary Care 2nd Ed
(2005). British Thoracic Society COPD Consortium. Accessed at: [LINK]

2. Dr Colin Tidy. Spirometry. Patient.info. Published 2nd Dec 2016. Accessed on 12th Dec
2017. [LINK]

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